tbuckley/cabot-search huggingface dataset:
Abstract 9513: Association of Statins for Primary Prevention of Cardiovascular Disease With Hospitalization for Covid-19: A Nationwide Matched Population-Based Cohort Study
Authors: Kim Bouillon, Berangere Baricault, Laura Semenzato, Jeremie Botton, Marion Bertrand, Jerome Drouin, Rosemary Dray-Spira, Alain Weill, Mahmoud Zureik
Journal: Circulation (2022)

Background: Numerous studies have reported a lower risk of serious in-hospital outcomes of COVID-19 associated with statin use. However, there is little evidence on the relationship between statin use and the risk of hospitalization due to COVID-19. Methods: The French National Health Insurance database was used to conduct a matched-cohort study. For each adult aged 40 years or more receiving statin for primary prevention of cardiovascular disease, one non-user was randomly selected matched for year of birth, sex, residence area, and comorbidities (hypertension, diabetes mellitus, and chronic respiratory condition). The association between statin use and hospitalization for COVID-19 was examined using the conditional Cox proportional hazards models, adjusted for baseline characteristics, comorbidities, and long-term medications. Its association with in-hospital death from COVID-19 was also investigated. Multivariable analysis weighted with inverse probability of treatment weights was also performed. All participants were followed-up from February 15 to June 15, 2020. Results: The 1:1 matching procedure generated 2,058,249 adults in the statin group and 2,058,249 in the control group composed of 46.6% of men with a mean age of 68.7 years. Statin users had a 16% lower risk of hospitalization for COVID-19 than non-users (adjusted hazard ratio (HR), 0.84; 95%CI, 0.81-0.88). All types of statin were significantly associated with a lower risk of hospitalization; adjusted HR ranging from 0.75 (95%CI, 0.57-0.99) for fluvastatin to 0.89 (95%CI, 0.84-0.95) for atorvastatin. Low- and moderate-intensity statins also showed a lower risk compared with non-users (HR, 0.78; 95%CI, 0.71-0.86 and HR, 0.84; 95%CI, 0.80-0.89, respectively) whereas high-intensity statins did not (HR, 1.01; 95%CI, 0.86-1.18). We found similar results with in-hospital death from COVID-19. Conclusions: Our findings support the hypothesis that the use of statin for primary prevention is associated with lower risks of hospitalization for COVID-19 and of in-hospital death from COVID-19.
Abstract 320: Gray-white Matter Ratio Under 1.12 Could Predict Poor Neurological Outcomes, Even When Measured Within Two Hours After Return Of Spontaneous Circulation
Authors: Yuya Murakami, Takashi Hongo, Toshihisa Ichiba, Atsuyoshi Iida, Hiroki Maeyama, Yoshinori Kosaki, Atunori Nakao, Hiromichi Naito
Journal: Circulation (2022)

Introduction: Literature on neuroprognostication suggests that gray-white matter ratio (GWR) measured from head computed tomography (CT) within two hours after return of spontaneous circulation (ROSC) can’t adequately predict neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients. However, severe cerebral edema may predict poor outcomes within two hours after ROSC. Hypothesis: We evaluated if GWR measurements obtained early after OHCA (≤ 2 hours) indicated poor neurological outcomes in patients with severe cerebral edema. Methods: We conducted a multicenter, retrospective cohort study using data from five hospitals collected between 2007 and 2019 in Japan. Inclusion criteria: adult comatose OHCA survivors with head CT within two hours after ROSC. Exclusion criteria was trauma, stroke, or pre-existing neurological disorders. Primary outcome was poor neurological outcome, defined as Cerebral Performance Category (CPC) score ≥ 3 at one month after admission. GWR was measured at the levels of the basal ganglia (BG), corpus callosum (CC), and posterior internal capsule (PIC). The prognostic value of GWR for predicting poor outcome was assessed using a receiver operating characteristic (ROC) curve analysis, area under the curve (AUC) with sensitivity/specificity. Results: A total of 377 patients were included. Of those, 281 (74.6%) exhibited poor neurological outcome at one month after admission. GWR values did not alter by the time of obtaining head CT: 1.22 (0-30 min: n=194); 1.22 (31-60 min: n=127); 1.22 (61-120 min: n=56). Using a cut-off GWR value of &lt;1.2, ROC analysis demonstrated AUC for GWR-BG (0.69, 95% CI 0.65-0.73), GWR-CC (0.77, 95% CI 0.69-0.76), and GWR-PIC (0.76, 95% CI 0.72-0.79) with sensitivities/specificities of 45.5%/92.7%, 47.6%/97.9%, 55.8%/96.8%, and 46.2%/97.9%, respectively for poor outcomes. However, GWR values &lt;1.12 demonstrated 100% specificity for poor outcomes: GWR-BG (AUC 0.56, sensitivity/specificity 13.5%/100%), GWR-CC (AUC 0.56, sensitivity/specificity 13.5%/100%), and GWR-PIC (AUC 0.59, sensitivity/specificity 19.5%/100%). Conclusion: GWR (&lt;1.12) obtained even within two hours after ROSC could be used as a threshold for poor neurological outcome in OHCA patients.
Abstract 330: Effect Of Covid-19 Mitigation On Resource Utilization And Rates Of Acute Myocardial Infarction In Areas Of Higher And Lower Socioeconomic Vulnerability
Authors: Eric Frantz, Adam Perzynski, Lance D Wilson, Joseph Piktel
Journal: Circulation (2022)

Background: Multiple reports demonstrate decreased emergency department (ED) utilization for cardiovascular emergencies during COVID-19. It is possible this decrease had downstream effects on the later severity of cardiovascular disease, especially in patients with higher social vulnerability. The purpose of this study was to determine the effect of early COVID-19 mitigation strategies on hospital resource utilization and acute myocardial infarction (AMI) admissions by social vulnerability. Methods: We retrospectively analyzed patients transported by emergency medical services (EMS) with a diagnosis of chest pain and/or AMI from a large urban Midwest EMS and single hospital system from Jan 1-Dec 31, 2020. Hospital office, telehealth, ED visits for chest pain, and hospital admissions for AMI were identified using the electronic health record. The 3 phases of COVID-19 mitigation were compared (pre-mitigation-Jan 1 st to Feb 28 th , mitigation-March 1 st to April 30 th , and post-mitigation-May 1 st -December 31 st ). The socioeconomic status theme of the Social Vulnerability Index (SVI) was determined. The primary outcome was rate of AMI per ED chest pain visit, which was compared between the highest and lowest SVI quartiles. Statistical comparisons were made using binary logistic regression and Chi-squared tests. Results: Overall, there was a similar increase in telehealth visits and a decrease in office visits during mitigation in both highest and lowest SVI quartiles. In the post-mitigation phase, patients with the highest social vulnerability had a 30% relative increase rate of AMI per ED chest pain visit (7.3% vs 5.5%, p=0.048) compared to patients with lower social vulnerability. This increase was not seen in the pre-mitigation (5.8% vs 6.1%) or mitigation (4.9% vs 5.4%, each p=ns) phases. Conclusions: After initial COVID-19 mitigation strategies were implemented patients with higher socioeconomic vulnerability presented to the ED with AMI at a higher rate than patients with a lower socioeconomic vulnerability, despite no differences in office, telehealth, or EMS transport. Understanding the complex effect of pandemic mitigation strategies on vulnerable populations can provide guidance for resource management in future crises.
Abstract 292: Non-Arrest PulsePoint Activations In Public And Private Settings
Authors: Jennifer E Blackwood, Mohamud R Daya, Ben Sorenson, Brian Schaeffer, Mike Dawson, Michael Charter, James M Nania, Julie Charbonneau, Jeremy Robertson, Michael Mancera, Chris Carbon, Dawn Jorgenson, Mengqi Gao, Richard Price, Thomas Rea
Journal: Circulation (2022)

Objectives: Geospatial “smart” technology such as PulsePoint is increasingly used to crowdsource community response for suspected out-of-hospital cardiac arrest (OHCA). Although the clinical focus of this strategy is OHCA, dispatch identification is imperfect such that activation often occurs for the non-arrest patient. The frequency and clinical profile of such non-arrest patients has not been well characterized. Methods: Prospective 3-year cohort investigation of patients for whom the PulsePoint was activated for suspected OHCA in four United States communities (total population ~1 million). We evaluated those patients with a PulsePoint activation for suspected OHCA who were subsequently not found to be in cardiac arrest on arrival. The response cohort included off-duty, volunteer public safety personnel (verified responders) notified regardless of location (public or private) as well as laypersons who were only notified to public locations. We linked the PulsePoint information with EMS records to report the frequency, condition type, and EMS treatment for these patients. Results: Of 1779 calls where volunteers were activated, 756 were OHCA, which left 1023 non-arrest patients for evaluation. The most common EMS assessments were syncope (15.9%, n=163), altered mental status (15.5%, n=159), seizure (14.3%, n=146), overdose (13.0%, n=133), and choking (10.5%, n=107). These findings were similar for private and public locations. The most common EMS interventions included placement of an intravenous line (43.1%, n=441), 12-Lead ECG (27.9%, n=285), naloxone administration (9.8%, n=100), and airway or ventilation assistance (8.7%, n=89). Conclusions: More than half of patients activated for suspected OHCA by PulsePoint in both public and private had conditions other than cardiac arrest. A subset of these conditions may benefit from earlier care provided by both layperson and public safety volunteers if they were appropriately trained and equipped.
Abstract 9262: The Clinical and Electrophysiologic Manifestations of Cardiac Tumors: A Single-Center Retrospective Study
Authors: David Madnick, Srilakshmi Vallabhaneni, Rupal OQuinn, Gustavo Guandalini, Sanjay Dixit, David S Frankel, Michael P RILEY, Saman Nazarian, Rajat Deo, David J Callans, Andrew E Epstein, Francis E Marchlinski, Michael Fradley, Matthew C Hyman
Journal: Circulation (2022)

Introduction: Cardiac tumors are rare and their effect on the cardiac conduction system is not well-described. Currently there is no recommendation for routine arrhythmia screening in this population. This study aimed to characterize the clinical presentation and electrophysiologic manifestations of patients with cardiac tumors. Methods: A radiologic database from a four-hospital health system was queried to identify patients with a cardiac tumor diagnosed on CMR from 2003-2021. The electronic health record, ECGs, arrhythmia monitors, echocardiograms and CMRs were reviewed for each patient. Results: Forty-nine patients were identified with intra-cardiac or pericardial tumors. The cohort had a mean age of 57.3 ±14.6 years old and was 53% female. Cardiovascular risk factors were prevalent: HTN (59%), HLD (43%), DM (26%), CAD (20%). Common presenting symptoms were SOB (30.6%), palpitations (24.5%) and chest pain (20.4%); many patients had no overt cardiac symptom (42.9%). By CMR, tumors were classified as pericardial (44.9%) vs myocardial (55.1%), primary tumor (57.1%) vs secondary tumor (42.9%) and located nearest the atrium (24.5%), ventricle (55.1%) or both (14.3%). Twenty-three patients (47%) had tumors that were labeled as malignant, with the most common diagnoses being diffuse large B-cell lymphoma (DLBCL, 10.2%), non-small cell lung cancer (8.2%) and melanoma (6.1%). Non-trivial pericardial effusions were common (24.5%), with one case complicated by tamponade. Seven patients (14.2%) were documented to have cardiac arrhythmias including one patient with sudden arrhythmic death (SAD). Neither pericardial effusion (OR 3.7, CI 0.5-29.6) nor atrial tumor location (OR 2.8, CI 0.4-21.8) was predictive of atrial fibrillation or SVT. Ventricular arrhythmias were observed in patients with ventricular tumors (11.8%), but not atrial tumors (0%). Sustained VT was found in two patients with invasive DLBCL. Conclusion: Cardiac tumors are associated with frequent cardiac symptoms, pericardial effusions and cardiac arrhythmia. Sustained VT was documented in two patients with DLBCL in the ventricle, one of whom experienced SAD. Prospective studies employing long-term rhythm monitoring may be warranted to inform the need for arrhythmia screening.
Abstract 294: Is Use Of An Interactive Voice Server In An Emergency Medical Dispatch Center An Efficient And Safe Measure?
Authors: MARGOT CASSUTO, MARIN BOYET, Jeremie Boutet, GUILLAUME DOUGE, ANNA OZGULER, Michel Baer, Thomas Loeb
Journal: Circulation (2022)

Introduction: In the first wave of COVID-19 pandemic, Emergency Medical Dispatch Centers (EMDC) faced an influx of calls. During this time, with the scope of handling emergency calls more quickly, it was decided to use an Interactive Voice Server (IVS). The objective of this study was to identify whether the implementation of an IVS is efficient and safe. Methods: From 20/03/19 until 20/04/26, an IVS was activated between 8 AM and midnight. IVS offered the caller to choose either 1- press the 'zero' key for Coronavirus Syndrome with no respiratory difficulties; or 2- stay on line for any other reason. If the caller typed "zero", the call was directed to a "crisis dispatcher" specially trained to handle COVID cases. If he stayed on line, his call was placed in the same queueing list as all emergency calls and handled by a “conventional dispatcher”. All medical dispatch files picked up during IVS activation period were included and classified in 2 groups: “IVS Yes” if caller pressed ‘zero’ and “IVS No” if not. Patient’s age, gender and profile of the caller (patient or third party) were collected. The level of severity of the patients was assessed upon the dispatcher’ decision ranging from sending an Advanced Life Support ambulance (ALS), a Basic Life Support ambulance (BLS) or no transport. Data were compared between the 2 groups with Chi-square tests. Results: 2846 callers were in the group “IVS Yes” and 12111 in “IVS No”. Main results are in table 1. Conclusion: IVS allowed almost 15% of calls to be directed to a specialized provider where they waited to be processed by staff trained within a few days to deal exclusively with COVID cases. This has led to decrease the number of calls handled by the conventional dispatch and allowed more time to respond to severe emergency calls. Moreover, because only 0.07% “IVS Yes” needed an ALS ambulance, we can assume that the use of IVS is safe. IVS is therefore an effective tool, which allows safe triage of less serious patients and frees up time to answer to severe calls.
Abstract 300: Evaluation Of An Electrocardiogram Based Analytic For Predicting Future Episodes Of Hemodynamic Instability
Authors: Bryce Benson, Ashwin Belle, Sooin Lee, Richard P Medlin
Journal: Circulation (2022)

Background: Clinicians rely on vital signs (tachycardia with hypotension) to identify hemodynamically unstable patients. The Analytic for Hemodynamic Instability (AHI) System provides an indication of hemodynamic deterioration before it is evident via vital signs. It uses only routinely collected ECG monitor data to generate a simple binary output (indicating signs of hemodynamic instability-Red or stability-Green) and is automatically updated every two minutes. Hypothesis: Continuous real-time hemodynamic status obtained from analysis of ECG signals can predict an episode of hemodynamic instability before it's evident via vital signs, with clinically actionable lead time. Methods: In this retrospective observational study, an episode of hemodynamic instability (EHI) was defined as 10 continuous minutes or more where hypotension (systolic BP&lt;90 mmHg or mean BP&lt;70 mmHg) combined with tachycardia (heart rate ≥ 100 bpm) was present. The AHI System processed continuous ECG data from 362 consecutive adult ICU patient encounters (146, 40.3% female) undergoing continuous BP and HR monitoring via arterial line and ECG, who experienced at least one EHI. In this analysis, only the first occurrence of an EHI per patient encounter was used to see if the AHI System predicted the episode before vital signs showed any indication. Results: Of the 362 patients, AHI correctly predicted the first EHI in 85% of the patients (308/362). Of those, AHI’s median lead time (predominantly repeating AHI-Red indications) was 57 minutes prior to first EHI, with 25th and 75th percentiles at 14 minutes and 3.2 hours, respectively. AHI’s average lead time was 4 hours. Conclusion: Results suggest that this ECG-based analytic can potentially notify healthcare providers of future patient deterioration with clinically actionable lead times. The benefit of this analytic could extend further for ECG monitored patients in lower levels of care where hemodynamic status is typically evaluated manually and intermittently. This potentially enables appropriate preemptive clinical action, thereby reducing failure to rescue and increasing vigilance for unseen at-risk patients. Footnote: AHI is an FDA-cleared device for sale in the US.
Abstract 305: Effect Of Initial Epinephrine Administration Time On Cerebral Perfusion In A Porcine Experimental Model Of Cardiac Arrest
Authors: Hyoukjae Lim, Kyoung Jun Song, Ki Jeong Hong, Hanna Yoon, Stephen Gyung Won LEE, Seul Ki Choi, Gyeongmin Lee, YongJoo Park, Wonpyo Hong, Kang bin Lee, Ki Hong Kim
Journal: Circulation (2022)

Background: The effect of initial epinephrine administration time from cardiac arrest on cerebral perfusion pressure (CePP) during CPR is controversial. The purpose of this study was to evaluate the association between initial epinephrine administration time and CePP in a porcine cardiac arrest model. Methods: Initial administration time of epinephrine was divided into 3 groups based on time after inducing ventricular fibrillation (VF): 5 minutes (early group), 10 minutes (intermediate group), and 15 minutes (delayed group). Twenty-four pigs were randomly assigned to each group. After 4 minutes of untreated ventricular fibrillation, 2 cycles of BLS (BLS1 and BLS2 phase) and 10 cycles of ACLS (ACLS1~10 phase) were conducted. Macrovascular circulation (CePP) and microvascular circulation using laser doppler flowmetry presented as a fraction of the baseline flow (f-LDF) were measured. Linear mixed model was used to measure median difference in CePP and f-LDF between groups. Results: A total of 22 pigs were analyzed. Early group showed higher and earlier peak of CePP and f-LDF compared to those of intermediate or delayed groups. There was a significant group by phase interaction in CePP where the early group showed a higher CePP on earlier phase. (Early group: median 38.2 [95% confidence intervals 30.7-50.5] mmHg at BLS 2 phase, intermediate group: 27.1 [14.1-35.7] mmHg at ACLS1 phase, late group: 12.2 [2.2-34.9] mmHg at ACLS 4 phase), p&lt; 0.001). There was no significant group by phase interaction in f-LDF; however, there was a tendency of decreased peak and delayed reach to peak with time. (Early group: median 5.7 [95% confidence interval 3.5-7.8] at ACLS 2 phase, intermediate group: 3.6 [1.5-5.1] at ACLS 4 phase, late group: 2.2 [0.9-3.3] at ACLS 6 phase, p =0.93). Conclusion: In this VF cardiac arrest porcine study, the early administration of epinephrine group showed higher and earlier peak of CePP and f-LDF compared to those of the intermediate and delayed groups.
Abstract 288: Incidence And Outcomes Of In-hospital Cardiac Arrest Among Pulmonary Arterial Hypertension-related Hospitalizations In The United States
Authors: Titilope Olanipekun, Temidayo Abe, Ndausung Udongwo, Valery S Effoe
Journal: Circulation (2022)

Background: Cardiac arrest is a known complication of Pulmonary arterial hypertension (PAH) often due to acute right heart failure and arrhythmias. However, data on trends in the incidence and in-hospital outcomes of in-hospital cardiac arrest (IHCA) among PAH-related hospitalizations in the US is limited. Hypothesis: IHCA incidence has declined and In-hospital outcomes improved among PAH-related hospitalizations. Methods: We identified hospitalizations with a primary diagnosis of PAH in the nationwide inpatient database between 2010 and 2019, using the appropriate international classification of disease codes. We extracted patients who underwent cardiopulmonary resuscitation for IHCA and evaluated temporal trends in the incidence and in-hospital outcomes using the Cochrane-Armitage test. Logistic regression was used to evaluate factors associated with odds of survival to hospital discharge. Results: We identified 18,772 PAH-related hospitalizations during the study period. The IHCA incidence rate was 1.8% with a mean age (SD) of 62 years (16) and females predominantly affected (62.8%). There was a non-significant decline in IHCA incidence rate between 2010 and 2019 (1.9% vs. 1.2%, P=0.08). The overall survival to hospital discharge rate was 30.4% and this increased significantly during the study period (26.7% vs 36.9%, P = 0.04). Most of the survivors were discharged to a long-term acute care facility (44.2%) and 18.% were discharged home without the need for home health care. Factors associated with lower odds of survival were age &gt; 65 years OR 0.97, 95% CI 0.96 - 0.98, P &lt; 0.001), acute right heart failure (OR 0.74, 95% CI 0.60 - 0.90, P&lt;0.001), acute respiratory failure (OR 0.20, 95% CI 0.16 - 0.24, P &lt; 0.001), and severe comorbidity index (OR 0.83, 95% CI 0.71-0.96, P &lt; 0.001). The presence of shockable rhythm (OR 1.67, 95% CI 1.31 - 2.26, P=0.03) and obesity (OR 1.33, 95% CI 1.02 - 1.72, P=0.03) were associated with higher odds of survival Conclusion: Though IHCA survival among resuscitated PAH-related hospitalizations improved during the 10-year study period in the US, only about 3 out of 10 patients still survive to hospital discharge. Additional studies are warranted to identify strategies that will improve resuscitation outcomes in these patients.
Abstract 283: Cardiac Functional Recovery At One Year In Refractory Out-of-hospital Cardiac Arrest Survivors
Authors: Adamantios Tsangaris, Tamas Alexy, Marinos Kosmopoulos, Rajat Kalra, Jason Bartos, Andrea M Elliott, Alejandra Gutierrez, Demetris Yannopoulos
Journal: Circulation (2022)

Introduction: The survival to discharge of patients presenting with refractory out-of-hospital cardiac arrest (OHCA) in centers with a well-established extracorporeal cardiopulmonary resuscitation (ECPR) program has improved over the last decade. While quality of life is an important consideration for all survivors, long-term cardiac functional recovery as defined by the New York Heart Association (NYHA) of this population remains unknown. Methods: We performed a single center, retrospective analysis to evaluate the functional cardiac recovery of refractory OHCA survivors receiving ECPR with VA-ECMO between 2016 and 2020. Relevant demographic information as well as data on admission characteristics and index hospitalization were collected (Table). NYHA functional class was assessed at one month and at one year after hospital discharge. All patients had a transthoracic echocardiogram before discharge. Results: We identified 54 patients that were discharged following ECPR for OHCA during the study period. Forty-six (85%) were alive at one year. Complete functional outcome data were available for 37 survivors. Compared to the first assessment at 1 month, 15 patients (41%) had symptomatic improvement of at least one NYHA class at 1 year ( Figure ). No patients experienced clinical deterioration. Left ventricular ejection fraction assessed pre-discharge was the only significantly different parameter between those with improved and unchanged NYHA class at one year ( Table ). Conclusions: A large proportion of refractory OHCA survivors treated with ECPR have substantial improvement in their NYHA functional status at 1 year.